Congenital heart disease (CHD) is the most common type of birth defect causing more deaths in the first year of life than any other birth defect. Medical practice in a third-world country is faced with numerous challenges, created by poor health facilities and the unavailability of basic imaging studies at the community level where the majority of the poor resides. We present a case series of 4 neonates with a ratio of 1: 3 admitted into the neonatology unit of the University of Calabar Teaching Hospital, Calabar, Nigeria. Two of the patients were delivered at home by a traditional birth attendant via spontaneous vertex delivery and the rest two were booked cases in a private and obstetric unit of the University of Calabar Teaching Hospital. Their age ranged were 18 hours to 27 days of life and their common presentation were poor sucking, difficulty in breathing, central cyanosis and failure to thrive. A fetal echocardiogram was carried out for one of the cases and there was strong clinical suspicion of congenital heart disease but the precise type is unknown. The other three could not afford the necessary investigations required. They were all oxygen-dependent till death. Pathologic-anatomic findings showed a rare Critical congenital heart defect of the univentricular heart chamber of various types for the three cases and a case of TGA. The Immediate cause of death for all four cases was congestive cardiac failure.

Background: Neonatal deaths are deaths of live born babies occurring before 28 completed days. The vast majority occur in low-income countries like Nigeria with a high neonatal mortality rate. There is paucity of autopsy studies due to refusal of family to give consent for such procedures. Aim: To identify the commonest causes of neonatal death in 53 neonatal autopsies in Calabar, Nigeria. Materials and Methods: Detailed postmortem was carried out using lettules techniques and bits taken for histological analysis to ascertain the cause of death. Other relevant contributory factors such as the gestational age, mode of delivery, place of birth, antemortem cause of deaths and maternal obstetric history were obtained from the medical records and autopsy request forms. Results: In the one-year retrospective study of 53 neonatal autopsies, male: female ratio was 1: 0.83 and mean age at death was 6.5 + 7.3 days, ranging from 1 to 28 days. The commonest cause of neonatal death was severe birth asphyxia seen in 10 cases (18.9%), followed by kernicterus in 6 cases (11.3%), birth trauma seen in 6 cases (11.3%), congenital heart disease seen in 5 cases (9.4%), and prematurity seen in 5 cases (9.4%). Conclusion: The study confirms the usefulness of neonatal autopsy in ascertaining the definitive cause of death. Severe birth Asphyxia was identified as the commonest cause of death in the neonatal period followed by birth trauma, kernicterus and congenital heart diseases.

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